January 2014

Permanent chemotherapy-induced alopecia in children associated with thiotepa

Chemotherapy-induced alopecia (CIA) is a frequent complication in patients with cancer. There are an increasing number of reports of permanent CIA.

Thiotepa use is strongly linked to permanent hair loss in children after hematopoietic stem cell transplantation, new findings show.

The incidence of permanent chemotherapy-induced alopecia (CIA), at 12%, was higher than in studies of adults, and the younger the patient, the greater their risk, said Dr. Ohsang Kwon of Seoul National University College of Medicine in Seoul, Korea, and colleagues.

Dr. Kwon and his team noted in a paper online December 18 in the Journal of the American Academy of Dermatology that while CIA has been investigated in adults, there is little information available on CIA in children.

All of the patients began the study with normal hair growth, and all developed alopecia during treatment, on average 1.5 months after chemotherapy began. Two-thirds of patients had reduced hair density after their hair grew back, and 45% of these patients complained of thinning hair. Most patients reported changes in hair color and texture after chemotherapy.

Hair regrowth began at 2.6 months after patients stopped chemotherapy, and continued for 7.3 months, on average. Nineteen of the patients, or 12%, had permanent CIA, which the investigators defined as "absent or incomplete hair regrowth at six months postchemotherapy."

The average age of the patients with permanent CIA was 5.2 years, versus 7.6 years for patients without permanent CIA.

Patients who received thiotepa had a roughly eight-fold increased risk of permanent CIA. Thiotepa is widely used to treat brain tumor, neuroblastoma, and other cancers, Dr. Kwon noted in an email interview, and there is currently no proven alternative to the drug.

"The reasons why younger children are at greater risk of permanent hair loss remain unclear," Dr. Kwon added. "It is proposed that the hair follicle stem cells of younger children could have higher plasticity but would be more vulnerable to attack (with chemicals) such as chemotherapeutic agents.

Another probable explanation would be the tight junction around niche where the hair follicle stem cells are localized may be less tight in young age than that of adults."

He concluded: "CIA produces a strong stigma of illness and is a distressing psychological burden for children at an impressionable age.

Therefore, appropriate information must be provided before and after chemotherapy and psychological support must be provided to the patients and their parents. We hope our study will raise awareness of CIA, including permanent CIA, in this population."